Case of the Month

A 28-year-old woman presented with mildly dry lips. Upon examination, her teeth (incidentally) were noted to have rust-brown colored stains.

She reported no use of tobacco or other chewed products including chewed stimulants.

Dental fluorosis, severe.

Dental fluorosis appears as faint white lines, blotches, dots or streaks on the teeth. Severe fluorosis can appear with various shades of brown. Dental fluorosis is a result of excess fluoride consumption, over time, before the teeth erupt. Once teeth cut the gums, fluorosis does not develop further. Fluorosis does not affect the overall health of teeth, and most cases of fluorosis are so subtle, only a dental professional or dentist can detect it.

In extreme cases, like the patient depicted here, the discoloration can manifest as significant rust-brown stains. Patients find this to be a significant cosmetic concern. I have several Somali patients, and this is a common finding for people who have lived in the northern areas of Somali where the natural fluoride content in drinking water is uncommonly high.

Paradoxically, teeth whitening can actually exacerbate the condition. Many patients have elected to obtain veneers or crowns for a more pleasing appearance. Other common causes of teeth discoloration include tobacco chewing and Khat chewing. Khat represents the leaves of an Arabian shrub, which is chewed as a stimulant, similar to coffee. Khat originally was and commonly is consumed in East Africa and Arabia. This patient had never consumed Khat but did grow up in northern Somalia. Her two siblings both have similar brown stains on their teeth, also.